Dr. Saltiel received his Pharm.D. from the University of California, San Francisco, in 1980, following undergraduate work at UCLA. At UCSF, he was the recipient of the Outstanding Service Award and the Bowl of Hygeia Award. He completed a residency in clinical pharmacy practice at the University of Illinois, in Chicago.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Carbamazepine (Tegretol) and phenytoin (Dilantin) markedly decrease the amount of topiramate in the body by increasing its elimination from the body. As a result, topiramate may lose effectiveness unless doses are increased.
Topiramate may decrease the amount of estrogen in the body in women taking oral contraceptives, possibly increasing the chances of unwanted pregnancy.
Patients with seizure disorders taking anticonvulsant medications, including topiramate, may develop nerve toxicity from a chemical, 4'-O-methylpyridoxine, found as a contaminant in some ginkgo preparations.
PREGNANCY: Topiramate has been associated with abnormalities of the fetus (teratogenicity) in experimental animal studies. No data on fetal effects of topiramate exists in humans.
NURSING MOTHERS: Topiramate is excreted in the milk of lactating rats. It is not known whether topiramate is excreted in human milk or if it has important effects on nursing infants.
SIDE EFFECTS: In adults, the most common side effects of topiramate are tiredness, dizziness, coordination problems, speech problems, changes in vision or double vision, difficulty with memory, and sensory distortion.
In children, the most common side effects are drowsiness,
tiredness, loss of appetite, nervousness, difficulty with
concentration/attention, weight decrease, aggressive reaction and difficulty
with memory.
Since topiramate was approved, there have been 23 cases reported (as of 8-17-01) of a sudden onset of vision and eye problems. Symptoms have typically occurred within the first month of therapy, with patients reporting an acute onset of decreased vision and/or eye pain. Eye examination revealed myopia (nearsightedness), redness, decreased depth of the anterior chamber of the eye and elevated ocular pressure, with or without dilation of the pupils. Fluid accumulation within the eye may displace the lens and iris anteriorly causing secondary angle closure glaucoma. If patients
develop this syndrome, the treatment is to discontinue topiramate as rapidly as
possible, according to the judgment of the treating physician.
Antiepileptic medications have been associated
with increased risk of suicidal thinking and behavior. Anyone
considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are
started on therapy should be closely observed for clinical worsening, suicidal
thoughts, or unusual changes in behavior.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Fragile X syndrome is the most common inherited form of mental retardation. It's caused by a mutation on the X chromosome. People with Fragile X syndrome suffer from physical, social, emotional, speech, language, sensory, intelligence, and learning impairments. There is no definitive treatment for Fragile X, though there are ways to minimize the symptoms.
Compulsive gambling is a disorder that affects millions in the U.S. Symptoms and signs include a preoccupation with gambling, lying to family or loved ones to hide gambling, committing crimes to finance gambling, and risking importance relationships and employment due to gambling. Treatment may incorporate participation in Gamblers' Anonymous, psychotherapy, and medications like carbamazepine, topiramate, lithium, naltrexone, antidepressants, clomipramine, and fluvoxamine.
Characteristics of binge eating disorder include eating more quickly than usual, eating until uncomfortably full, eating a lot of food despite not being hungry, eating alone due to embarrassment, and feeling disgusted by overeating. Depression may be a cause of binge eating disorder. Risks of binge eating include weight gain, diabetes, high blood pressure, high cholesterol, heart disease, and some cancers.
Nightmares are dreams that cause high anxiety or terror. Nightmares may be a part of posttraumatic stress disorder (PTSD), and they usually occur during rapid eye movement (REM) sleep. There are several different treatment options for nightmares, including cognitive-behavioral therapy and medications.
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